Full Name:
Phone Number:
Date of Birth   
Email Address:
Name of animal you are interested in (Given by Sanctuary)?:
Describe a day in the life of this animal if you adopt?:
What is the primary reason for wanting to adopt?:
Do you own any animals currently or in the past? Give name, age, and breed.:
Have all your animals (past and present) been up to date on all vaccinations and given monthly Heartworm prevention?:
Are your animals spayed/neutered? If not, explain.:
Are your pets indoor or outdoor? If outdoor, do they have dog house or adequate shelter?:
Have any of your animals shown aggression towards people or other animals?:
Who is your current vet? List name, number, and location.:
Do you have fenced yard/pen/invisible fence?:
What is height, size, and type of fencing? Is it completely fenced?:
Do you own a pool? If so, do you have steps or ladder for easy exit?:
Do you live near main highway or busy road with high traffic?:
Do you live in neighborhood or on land? If land – how many acres?:
Have you ever surrendered a pet to a shelter OR given away? If so, explain.:
If adopting a cat, have you ever had any of your cats declawed?:
What are the ages of the children living in the home?:
Are you aware that animals are unpredictable around children?:
Do you understand that it is your responsibility to make sure children do not abuse or provoke this animal?:
How many hours will your pet be left alone during the day and/or night?:
Will you crate this animal? If so, how long?:
Do you bring your animal indoors during extreme heat and or cold?:
Have you or anyone in your family ever been arrested/fined or subject in an investigation involving animal cruelty?:
Are you aware that the average costs a year for owning a dog or cat could be up to $1000? Are you prepared for this kind of financial responsibility for owning an animal?:
Would you take this animal with you if you had to move?:
Do you take your dog or plan on taking this dog on daily walks?:
Do you or anyone in your family have allergies to pets?:
If so, have you owned a pet in the past without it becoming a problem?:
Housing  Own house
Live in apartment (provide name and number and proof of pet deposit)
Live in Mobile/Manufactured Home (provide name and number of landlord)
Rent a house (provide name and number of landlord)
Housing More Information:
What county to you live?:
Does anyone smoke inside your home?:
Do you understand that our adoption fee is non-refundable?:         
I understand all questions and all my answers are true and accurate. I am aware that ANY false information will be immediate denial of adoption.

Contact Information

In this area, you can enter text about your contact form. You may want to explain what happens after a visitor submits the form and include a contact phone number.

First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Evening Phone: